ICU nurses are frequently a tough-skinned crowd. ER nurses, too. You need a thick skin because you're surrounded by death and dying every single day. Med-surg just isn't like it. And when you as an RN are feeling that your patient is circling the drain, you need someone to pay attention to it NOW.
I don't yell. A crisis actually makes me calmer. It makes me no less assertive.
I had two nurses stare blankly at me one day, because I calmly said to them, "Could one of you get the crash cart, please?" When they didn't move, I said a little louder, "NOW, please." ...They literally shook their heads like in a cartoon. It didn't register at first because I said it calmly and I used 'please." That's how I am.
I'm at a teaching hospital now, and working in a clinic. Residents do the first assessments on burns some days. I've been there six weeks in clinic, but I have a lot of experience before that. The residents will be talking to the patient, and the MDs still look at me when they say, "This looks like a third degree burn with some cellulitis..." They're looking for a slight nod of my head to agree with them. And when the residents don't know which wound care is appropriate, they'll say something like, "And I'll let (me) do the wound care for you." And I dress it, and teach the patient (and resident)...who usually observes, and needs only to see it once. Then the next visit, they take over.
That's what you'll be able to do with time. In the ICU, it means during a code, you might toss out a suggestion for lidocaine....or it means that for a crazy patient, you say, "Doctor, would you like to start precedex now?" or "Have you thought about dopamine?" (when you have the bag already in your hand, and spiked...) ...instead of "Doctor, what do I do?'
It takes time. The next time you're at a code, get into the middle of it. Don't watch on the sides. At the codes at my last ICU, anyone who said, "I haven't done compressions in awhile" got to jump on the chest. Don't ask if you can drop drugs...know your ACLS, and get the next bristojet ready to drop and nudge your way over to the iv access.
You'll get there.